Acne vulgaris is treated with topical retinoids as first-line therapy. The purpose of this systematic review is to assess the effectiveness, safety, and tolerability of topical retinoids licensed for the treatment of acne vulgaris in the United States.

Clinical studies examining both effectiveness and safety/tolerability of topical retinoids authorized in the United States for the treatment of acne vulgaris were published between January 1, 2008, and September 1, 2018. Exclusion criteria included clinical studies with 20 or fewer patients, children under the age of 12, and topical retinoid combination therapy with moisturizers or aloe vera. Based on the selection criteria, 54 clinical trials were chosen from 424 search results.

In terms of enhancing Investigator Global Assessment and Investigator’s Static Global Assessment (24.1–28.8% and 13.3–17.3%, respectively; p < 0.001), topical retinoids with the combination of benzoyl peroxide led to the IGA improvement compared with vehicle (26.1–34.9% vs 7–11.8%; p < 0.001) by Week 12. Topical retinoid with an oral antibiotic was superior to the vehicle for reducing the lesion counts (64–78.9% vs 41–56.8%, p < 0.001). No significant difference was noticed in the efficacy between tazarotene and tretinoin. Tretinoin 0.05% resulted in the 62% patients experiencing AEs compared with adapalene 0.1% (19%) and adapalene 0.3% (40%). Patients who received adapalene were tolerant of the AEs compared with tazarotene (55.4% vs 24.4%; p < 0.0012). Consumption of topical retinoids is safe for the treatment of acne vulgaris.